Demonstration Of A Novel Commercialized Collagen Scaffold Patch Used In Anterior Leaflet Augmentation Through A Totally Endoscopic Robotic Approach

Anterior Mitral Valve Leaflet Augmentation Repair in Type III Mitral Regurgitation: Lessons LearnedThomas Kelley, Jr., James McCarthy, He Wang, Nels D. Carroll, Mohammed Kashem, G William Moser, Yoshiya Toyoda, Grayson H. Wheatley, Larry Kaiser,T. Sloane Guy

1The views in this presentation are those of the authors and do not represent those of the DOD or U.S. Army

Senior author is consultant for Medtronic and Edwards LifesciencesDisclosuresThese views do represent the views of the DOD

Sr. author is consultant for medtronic and edwards lifesciences, recently lectured for Admedus (cardiocell). 2Type III MR: The ProblemCarpentier Type III MR is plagued by high recurrent MR rate.Various strategies have been attempted without proven long-term success.Replacement is becoming mainstream option, particularly for IMR.Contributing issues include poor leaflet coaptation, poor leaflet tissue, and ventricular remodeling.3Simple Technique for Leaflet Augmentation

Artwork: Aubert, S., Flecher, E., Rubin, S., Acar, C., & Gandjbakhch, I. (2007). Anterior Mitral Leaflet Augmentation With Autologous Pericardium. The Annals of Thoracic Surgery,83, 1560-1561The base of the AML was incised from trigone to trigone using a scalpel blade manipulated by the robotic arms. The size of the resulting incision was measured.

Goal is improving coapatation by bring anterior leaflet to posterior leaflet. Annular downsizing with small ridged ring and replacment

A piece of ECM was then cut to these dimensions and the sutured with a running stitch.

A flexible band annuloplasty was then performed.

The procedure was reproducible with little or no variation. We had combined this procedure with the Davinci surgical system to make it as minimally invasive as possible.

4Minimally Invasive Robotic Approach (22/25 patients)

Robotic port placementEndovascular bypass5CorMatrixExtracellular matrix (ECM) produced from porcine small intestine submucosa. Early animal and human studies with valve repair demonstrated good function and evidence of reabsorption.Largest published study in adults using this material for mitral leaflet repairs reported patch issues in 2 of 19 cases (10.5%)When looking for an appropriate patch to avoid calcification, we felt cormatrix ECM would provide the characteristics required : mobility, host integration and little chance of calcificiation. 6Echo Images Intra-operative

Pre-repairPost-repairStudySingle center retrospective from 2012-13. 25 patients had anterior leaflet augmentation with CorMatrix.All repairs were for Type III MR.Mean age 63.3 12.2 years, 9 males (36%).Mean follow up of 10.6 months. No more than trace MR at discharge in all patients

ResultsRecurrence of severe MR in 8 patients (32%)Mean time to recurrence 219 days7 elected for re-operation5 patients had re-do mitral valve replacement2 re-do repairs of redundant graft tissue: both then failed due to patch dilatation. Univariate analysis Only BMI